Active NPI
Michelle A Grimm, M.ED
- Professional Counselor
- Shawano, WI
National Provider Identifier
1568657195
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 3370125
- Practice address
- 504 Lakeland Rd
Shawano, WI 54166-3836 - Phone
- (715) 526-5547
- Fax
- (715) 526-5542
- NPI assigned
- Sep 6, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 14267 | WI | |
| Professional Counselor | 101YP2500X | 3370125 | WI | Primary |
Addresses
Primary practice location
504 Lakeland Rd
Shawano, WI 54166-3836
Mailing address
504 Lakeland Rd
Shawano, WI 54166-3836
Phone (715) 526-5547
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 40968400 | Medicaid | WI |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Education
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 14267 | WI | MD | Addiction (Substance Use Disorder) Counselor |
| 3370125 | WI | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1189036800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1189036800000",
"number": "1568657195",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "504 LAKELAND RD",
"city": "SHAWANO",
"state": "WI",
"postal_code": "541663836",
"telephone_number": "715-526-5547"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "504 LAKELAND RD",
"city": "SHAWANO",
"state": "WI",
"postal_code": "541663836",
"telephone_number": "715-526-5547",
"fax_number": "715-526-5542"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GRIMM",
"first_name": "MICHELLE",
"middle_name": "A",
"credential": "M.ED",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-09-06",
"last_updated": "2007-09-06",
"status": "A"
},
"taxonomies": [
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "WI",
"license": "14267",
"primary": false
},
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "WI",
"license": "3370125",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "40968400",
"state": "WI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Shawano, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 6, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.